CPT code 81208: BCR-ABL1 test, other breakpoint2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This molecular test detects or quantifies BCR-ABL1 rearrangements involving an other breakpoint during evaluation or monitoring of leukemia.
Medicare pays $214.62 for 81208 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$214.62
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- CMS updates
- Quarterly
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 8 sections
What 81208 covers
This molecular test detects or measures the BCR-ABL1 rearrangement associated with the Philadelphia chromosome when the breakpoint is outside the major and minor breakpoint categories. It may be used in evaluating or monitoring leukemias such as chronic myeloid leukemia and Philadelphia chromosome–positive acute lymphoblastic leukemia. Testing is generally performed by a molecular laboratory on peripheral blood or bone marrow specimens; hematologists and oncologists commonly order it as part of the diagnostic or disease-monitoring workup.
The code covers qualitative or quantitative analysis for the other-breakpoint category; choose the code that matches the breakpoint being analyzed. Medicare pays the test through the CLFS only. The 2026 national CLFS amount is $214.62, unchanged since 2020; one national amount applies across localities, with no office or facility payment difference. The physician fee schedule lists the test as excluded by statute, so it is not paid through that schedule.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 81208
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 81208. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 81208 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81208 on the lab fee schedule since 2020
81208 · CLFS 2026 Q4 (current)
$214.62
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
81208 compared with similar tests
- 81206BCR-ABL1 testMajor breakpoint$163.96
- Use 81206 when testing targets the BCR-ABL1 major-breakpoint category. 81208 is for the other-breakpoint category.
- 81207BCR::ABL1 testMinor breakpoint$144.84
- Use 81207 when testing targets the BCR-ABL1 minor-breakpoint category. 81208 is for the other-breakpoint category.
81208 billing questions
How does 81208 differ from 81206 and 81207?
81208 is for BCR-ABL1 analysis in the other-breakpoint category. Use 81206 for the major-breakpoint category and 81207 for the minor-breakpoint category.
Does qualitative versus quantitative testing change the code?
No. Both qualitative and quantitative analysis are included in 81208 when the test addresses the other-breakpoint category.
What specimen is used?
Peripheral blood and bone marrow are commonly used for BCR-ABL1 testing. The appropriate specimen depends on the clinical workup and the laboratory's testing process.
Is modifier 26 used for a physician interpretation?
Medicare classifies 81208 as a CLFS-only test, rather than a physician-fee-schedule service. The physician fee schedule does not provide a separate payment pathway for this code.
How does Medicare pay 81208?
Medicare pays it under the CLFS at one national amount per code. The amount is the same across localities and does not vary between office and facility settings.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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